Voluntary Benefit Programs

About the Plan

Appeals

Claims And Appeals Procedure

If your claim or that of your dependent(s) for any benefit is wholly or partially denied by the Plan Administrator or insurance carrier, you will be provided with a written determination explaining the reasons for the denial.

Designation Of An Authorized Representative

You can designate another person to act on your behalf in the handling of your benefit claims. In order to do so, you must complete and file a form with the Plan Administrator and/or the insurance carrier that identifies the individual that is authorized to act on your behalf as your authorized representative. If you designate an authorized representative to act on your behalf, all correspondence and benefit determinations will be directed to your authorized representative, unless you direct otherwise. You may also request that this information be provided to both you and your authorized representative.

Insured Claims

Life insurance benefits are provided through Pacific Guardian Life Insurance Company. Short-Term Income Protection Insurance benefits are provided through American Fidelity Assurance Company and Long-Term Income Protection Insurance benefits are provided through the Hartford Life and Accident Insurance Company. Long-Term Care Insurance benefits are provided through Unum Life Insurance Company. If you have any questions regarding the claims and appeals procedures for these insured plans, contact the carrier at the address listed below.

The Trust Office serves as the Plan Administrator of the HSTA Voluntary Employees Beneficiary Association Trust and maintains the records regarding your eligibility for benefits. Questions regarding enrollment, change in employee status, or change in dependent coverage should be directed to the Trust Office. Any disagreement regarding your eligibility status or the status of your dependent that cannot be resolved by the Plan Administrator may be submitted to the Board of Trustees for review.

You have the right to appeal any decision of the Plan Administrator based on Plan rules adopted by the Board of Trustees (e.g., denial of eligibility or loss of eligibility) by filing a written request for review with the Board of Trustees. Your written request should be filed within 60 days after notification of the Plan Administrator’s decision and describe your version of the facts and reasons why you feel that the decision was not proper. You should submit any documents, records, and other information in support of your claim not already furnished to the Plan. If you wish, you (or your authorized representative) may review and obtain copies of all Plan documents, records, and other information relevant to your claim, free of charge.

Upon receipt of your written request for review, the Board of Trustees (or a sub-committee thereof) will review your case and take into account all evidence submitted by you (or your authorized representative), without regard to whether such evidence was submitted or considered in the initial claim determination. The Board of Trustees (or a subcommittee thereof) will determine whether or not a hearing will be held on your case. If a hearing is to be held, you will be notified of the time and place at least two weeks in advance of the hearing (unless you agree in writing to a shorter notice period). You and/or your authorized representative may appear at the hearing.

The Board of Trustees (or sub-committee thereof) will render its decision within 60 days after receipt of your written request, unless special circumstances require an extension of time for processing your request, in which case the decision shall be rendered as soon as possible, but not later than 120 days after receipt of your written request. If an extension is required, the Board of Trustees (or sub-committee thereof) will notify you, in writing, prior to the end of the initial 60-day review period and indicate the special circumstances that make the extension necessary and the date by which a decision is expected.

The decision of the Board of Trustees (or sub-committee thereof) will be written in clear, easily understood language and provide the reasons for their decision and the specific Plan provisions that support it. If you disagree with the decision on review, you may file suit in Federal or state court. If your suit is successful, the court may award you legal costs, including attorneys’ fees.